Why Swachh Bharat Mission could raise India's standing in Global Hunger Index
✽ Child wasting is a serious health concern
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Child wasting is a sign of poor nutrition, but so are stunting, underweight children and under 5 mortality. Whilst child wasting has worsened, other indicators have steadily improved. Nutrition has been bolstered by various food distribution schemes since 1975 but beset by poor targeting and delivery. Obviously other adversities are causing wasting and keeping stunting high at 38%. Water-borne diseases, caused by unsafe drinking water or poor hygiene is one such factor. While the child does not perish, he suffers from below par physical growth.
✽ Factors besides nutrition were responsible
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Though improvements in underweight children and stunting were seen across States, data doesn't show that better nutritional interventions resulted in better outcomes. Author believes that two more pertinent factors in the improvements were open defecation and the status of women. Ill-effects of open defecation extend to contamination of ground water and go beyond those who have poor access to sanitation. Urban households from well-to-do backgrounds suffered shortening because they lived in neighbourhoods where open defecation was prevalent. Pregnant women from low socio-economic groups are more likely to suffer from low nutrition, exposure to biological hazards, neglect and lack of access to health care. Thus improving hygiene, sanitation and fighting related infections are necessary for improving child health.
✽ Dedicated focus on sanitation is underway
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Last year, rotavirus vaccine against diarrhoea was made part of public immunisation program. Over 51m rural households were given toilets under SBM since 2/10/14—leaving just 30% to be covered,—and 1325 cities have been declared open-defecation free.
Fixing the targeting and delivery of nutritional schemes
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NFHS 2015-16 survey found prevalence of underweight (35.7%), stunting (38.4%), wasting (21%) and anemia (58.4%). Report talks of inter-generational undernourishment due to multiple deprivations— caused by or related to poverty, social exclusion and gender discrimination. It found differences between communities in the same soicio-economic grouping.
✽ Effort to improve delivery of nutrition
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Niti Aayog action plan calls for reshaping existing schemes and progressively covering all districts in 3 years starting from 2017-18. Govt wants to improve quality of supplementary nutrition and make delivery systems more efficient. Focus will be to improve nutritional outcomes —along with administrative changes— rather than merely distributing rations on per capita basis.
Fixing socioeconomic issues in laggard states can make a decisive impact to social progress (as seen in state child mortality efforts). Govt will use the targeted approach that worked so well for Beti Bachao Beti Padhao scheme. It will first work intensely in 113 worst districts. For example a conference was held recently to engage experts and district officials — "The deputy commissioners, district collectors along with other district level functionaries will have to take responsibility for the mission to eliminate malnutrition by 2022."
✽ Proposed monitoring and tracking
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Remote monitoring will be done by cloud telephony and Interactive Voice Response service. Daily data from Anganwadi Centres —which provide hot cooked food—will be uploaded to a web portal. Cases of severe malnutrition will be reported separately. Nutritional Social Audit will collate various metrics and publicize data on apps and websites. Undernourishment will be mapped to identify endemic zones & vulnerable districts.
GIS will track severely undernourished children and families as they move across India, with view to providing continuity of care, feeding and medical assistance. It will also help link up to various schemes for social development, food security, employment, etc.
Targeted approach works for infant mortality rate
-------------------------------------------------------------
“Our focus on low-performing states is paying off, with improved countrywide health coverage for reproductive, maternal and newborn health services." IMR has fallen sharply from 37 to 34 in 1 year—along with 10 point reduction in gender gap!! Outcome is being attributed to much higher institutional births (now 80%), immunizations and promotion of breast feeding. Delayed marriages & fewer adolescent pregnancies have helped.
✽ Child wasting is a serious health concern
Child wasting is a sign of poor nutrition, but so are stunting, underweight children and under 5 mortality. Whilst child wasting has worsened, other indicators have steadily improved. Nutrition has been bolstered by various food distribution schemes since 1975 but beset by poor targeting and delivery. Obviously other adversities are causing wasting and keeping stunting high at 38%. Water-borne diseases, caused by unsafe drinking water or poor hygiene is one such factor. While the child does not perish, he suffers from below par physical growth.
✽ Factors besides nutrition were responsible
Though improvements in underweight children and stunting were seen across States, data doesn't show that better nutritional interventions resulted in better outcomes. Author believes that two more pertinent factors in the improvements were open defecation and the status of women. Ill-effects of open defecation extend to contamination of ground water and go beyond those who have poor access to sanitation. Urban households from well-to-do backgrounds suffered shortening because they lived in neighbourhoods where open defecation was prevalent. Pregnant women from low socio-economic groups are more likely to suffer from low nutrition, exposure to biological hazards, neglect and lack of access to health care. Thus improving hygiene, sanitation and fighting related infections are necessary for improving child health.
✽ Dedicated focus on sanitation is underway
Last year, rotavirus vaccine against diarrhoea was made part of public immunisation program. Over 51m rural households were given toilets under SBM since 2/10/14—leaving just 30% to be covered,—and 1325 cities have been declared open-defecation free.
Fixing the targeting and delivery of nutritional schemes
NFHS 2015-16 survey found prevalence of underweight (35.7%), stunting (38.4%), wasting (21%) and anemia (58.4%). Report talks of inter-generational undernourishment due to multiple deprivations— caused by or related to poverty, social exclusion and gender discrimination. It found differences between communities in the same soicio-economic grouping.
✽ Effort to improve delivery of nutrition
Niti Aayog action plan calls for reshaping existing schemes and progressively covering all districts in 3 years starting from 2017-18. Govt wants to improve quality of supplementary nutrition and make delivery systems more efficient. Focus will be to improve nutritional outcomes —along with administrative changes— rather than merely distributing rations on per capita basis.
Fixing socioeconomic issues in laggard states can make a decisive impact to social progress (as seen in state child mortality efforts). Govt will use the targeted approach that worked so well for Beti Bachao Beti Padhao scheme. It will first work intensely in 113 worst districts. For example a conference was held recently to engage experts and district officials — "The deputy commissioners, district collectors along with other district level functionaries will have to take responsibility for the mission to eliminate malnutrition by 2022."
✽ Proposed monitoring and tracking
Remote monitoring will be done by cloud telephony and Interactive Voice Response service. Daily data from Anganwadi Centres —which provide hot cooked food—will be uploaded to a web portal. Cases of severe malnutrition will be reported separately. Nutritional Social Audit will collate various metrics and publicize data on apps and websites. Undernourishment will be mapped to identify endemic zones & vulnerable districts.
GIS will track severely undernourished children and families as they move across India, with view to providing continuity of care, feeding and medical assistance. It will also help link up to various schemes for social development, food security, employment, etc.
Targeted approach works for infant mortality rate
“Our focus on low-performing states is paying off, with improved countrywide health coverage for reproductive, maternal and newborn health services." IMR has fallen sharply from 37 to 34 in 1 year—along with 10 point reduction in gender gap!! Outcome is being attributed to much higher institutional births (now 80%), immunizations and promotion of breast feeding. Delayed marriages & fewer adolescent pregnancies have helped.
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- 3-part series on health and social outcomes in India based on data from NFHS 2015-16.
1.
livemint.com - India’s double burden of malnutrition - Livemint
2.
http://www.livemint.com/Politics/MAbkHJ0jYZ1hu9G0obNXiK/What-explains-Indias-high-child-malnutrition-rates.html
3.
http://www.livemint.com/Politics/pfqm3WGSJIIyMqGCbzdNXO/Indias-deepening-gender-imbalance.htmlREPLY Oct 16, 2017 - Aug 2015
Though improvements in underweight children and stunting was seen across States, data doesn't show that better nutritional interventions resulted in better outcomes. Author believes that two more pertinent factors in the improvements were open defecation and the status of women. Open defecation creates exposure to biological hazards. Pregnant women from low socio-economic groups are more likely to be suffer from low nutrition, exposure to biological hazards, neglect and lack of access to health care.
MALNUTRITION - state anaylsis------------------------------------------------
Despite years of rapid economic growth, child malnutrition rates had remained stubbornly unchanged. Finally there are signs of progress, although malnutrition rates remain high.
Malnutrition rates vary widely across states and income groups. Some of the most malnourished states of the country have seen biggest gains. Malnutrition is lower in higher income households. While improvement in poverty rates should have played a role in reducing malnutrition, analysis shows little evidence for it.
Analysis of states where the decline in poverty was faster than the national average between 2004-05 and 2011-12 shows that the link between poverty reduction and improvements in nutrition is at best a weak one. Nor is there a strong link between improvements in PDS or ICDS performance and nutritional outcomes. PDS is financial benefit given to states. ICDS is India’s biggest intervention to fight child malnutrition.
States with low rates of open defecation seem to have better nutritional outcomes, and vice versa. In the absence of sanitation facilities, children frequently fall prey to common infectious diseases which reduce their ability to absorb nutrients and grow.
Low birth weight babies start life with a nutritional disadvantage, and many of them remain underweight even as they grow up. High incidence of low birth weight babies is a reflection of the low social status of women, as they do not receive adequate nourishment or care prior to childbirth. States with low ratio of low birth babies also have high sex ratio (higher females to males).
REPLY Oct 16, 2017 - Govt wants to improve quality of supplementary nutrition and make delivery systems more efficient. Focus will be to improve nutritional outcomes —along with administrative changes— rather than merely distributing rations on per capita basis. Fixing socio-economic issues in laggard states can make a decisive impact to social progress. Govt will do that with targeted approach that worked so well for Beti Bachao Beti Padhao scheme. It will first work intensely in 113 worst districts. For example a conference was held recently to engage experts and district officials — "The deputy commissioners, district collectors along with other district level functionaries will have to take responsibility for the mission to eliminate malnutrition by 2022."
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Few performing states have made big strides in reducing child mortality. 1 million lives were saved in the last decade, yet 2 million more could have been saved had laggards measured up with outperforming states like Maha, TN & Karn. Though socio-economic challenges are huge, this can't begin without a wholesale change in political and bureaucratic mindsets.
http://www.livemint.com/Opinion/od5Un3KGo0pq12SI5P2TIK/Closing-the-gap.html
The government will soon issue guidelines on supplementary nutrition to tackle malnutrition among children, women and child development minister Maneka Gandhi said.
The new guidelines will supersede all existing ones, Gandhi said at the national conference “Mission Mode to address Under-Nutrition” on Tuesday.
“After the resounding success of Prime Minister Narendra Modi’s Beti Bachao Beti Padhao programme, the women and child development ministry is now targeting malnutrition. For this, there is an urgent need to improve the quality of supplementary nutrition and also make the delivery system efficient,” said Gandhi.
“We must provide 1,000 calories to women and 600 calories to children under Integrated Child Development Services (ICDS). The focus of the entire programme should be to administer nutrition rather than feeding beneficiaries by giving “Nutrient Dense Food”. A change in policy is required to implement this,” she said. The government is aiming to eliminate malnutrition in children by 2022.
The conference was attended by district collectors, deputy commissioners, district magistrates and district-level officers of health & family welfare, nutrition, drinking water & sanitation departments in the 113 high burden districts, besides principal secretaries, and secretaries of all states and union territories.
“The country has succeeded in eliminating several difficult problems like chickenpox and polio; it should not be difficult for the country to overcome the problem of malnutrition. The deputy commissioners/district collectors along with other district level functionaries will have to take responsibility for the mission to eliminate malnutrition by 2022,” said Virendra Kumar, minister of state for women and child development.
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REPLY Oct 19, 2017 - Niti Aayog action plan calls for reshaping existing schemes and progressively covering all districts in 3 years starting from 2017-18. Remote monitoring will be done by cloud telephony and Interactive Voice Response service. Daily data from Anganwadi Centres —which provide hot cooked food—will be uploaded to a web portal. After establishing new admin structures in each district, a Nutritional Social Audit will track various metrics and publicize data on apps and websites. *
*Undernourishment will be mapped to identify endemic zones & vulnerable districts. Cases of severe nutrition will be reported separately. GIS will track severely undernourished children and families as they move across India, with the view to providing continuity of care, feeding and medical assistance. It can also link up to various schemes for social development, food security, employment, etc.
NFHS 2015-16 survey found prevalence of underweight (35.7%), stunting (38.4%), wasting (21%) and anemia (58.4%). Report talks of inter-generational under-nourishment due to multiple deprivations— caused by or related to poverty, social exclusion and gender discrimination. It found differences between communities that are within the same soicio-economic grouping.
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In a new approach to tracking malnutrition among Indian children, the ministries of women and child development and health and family welfare, along with other departments, plan to focus on high malnutrition areas and put in place a digital surveillance system.
The plan will be executed under the National Nutrition Strategy proposed by government think tank NITI Aayog.
The government will cover districts already identified under various programs, i.e. 184 high priority districts under National Health Mission, 200 districts under Integrated Child Development Services Scheme (ICDS), 162 districts covered under ICDS Systems Strengthening & Nutrition Improvement Project (ISSNIP), with flexibility to states in the finalization of districts.
In Phase I (2017-18), 254 districts and identified urban areas will be covered; in Phase II (2018-19) additional 254 districts will be covered, totaling to 508 districts; and Phase III (2019-20) will cover the remaining districts based on needs assessment and performance.
Once nutrition is provided under various nutrition programs, the government will conduct Nutrition Social Audits to track the children and their health progress. At national and state levels, a website and necessary apps will be created for this.
“A part of the problem could be addressed by monitoring through Cloud Telephony and Interactive Voice Response Service (IVRS)-based daily monitoring system for hot cooked food in the Anganwadi centres (AWCs). The mobile phone-based daily monitoring IVRS system, is a two-way direct communication system between the state headquarter and the Anganwadi workers (AWWs). The software receives real-time data on daily basis from the AWWs regarding number of children being served hot cooked meal and simultaneously makes it available on the web portal,” NITI Aayog chief executive Amitabh Kant said.
NITI Aayog has also proposed setting up a National Nutrition Surveillance System. “Mapping of undernourished endemic zones of the country in terms of identifying ‘high risk and vulnerable districts’ for the rest of districts, cases of severe under nutrition in children should be included in the routine disease reporting system,” NITI Aayog has recommended.
The nutrition surveillance system will be geographic information system (GIS)-based for tracking severely undernourished children, families and communities in the long run. “This will not only ensure child-wise tracking, appropriate care, feeding and medical interventions for severely undernourished children but also help link the families of severely undernourished children with social protection measures, food security measures and to access employment through Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) and other livelihood options,” NITI Aayog further recommended.
Nearly every third child in India is undernourished—underweight (35.7%) or stunted (38.4%) and 21% of children under five years are wasted as per National Family Health Survey (NFHS-4) 2015-16. Moreover, the NFHS-4 data indicates that every second child is anemic (58.4%).
This intergenerational cycle of under nutrition is accentuated by multiple deprivations related to poverty, social exclusion and gender discrimination. Nutrition vulnerabilities are compounded by differentials in socio-economic status and vary by vulnerable community groups such as scheduled castes (SC) and scheduled tribes (ST).
REPLY Oct 19, 2017 - Oct 16, 2017
- Infant Mortality Rate sees a big drop - benefit of targeted approach
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8% reduction in IMR in 1 year, because of much higher institutional births (80% now in hospital), promotion of breast feeding & immunizations and delayed marriages & fewer adolescent pregnancies. Reduction in gender difference from 20 points to 10 points and a small fall in rural-urban divide.
Government had targeted 184 worst districts. Free health services for pregnant women and newborns also helped.
“The results signify that the strategic approach of the ministry has started yielding dividends and the efforts of focusing on low-performing states is paying off,” a statement by the ministry of health and family welfare said. It attributed the improvement to countrywide efforts to expand health services coverage, including reproductive, maternal and newborn health services.
REPLY Oct 20, 2017
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